| NPI | 1073298493 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACIE MARIE RIDGLEY Owner 903-530-4474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2023-06-21 |